We are a branch of a larger market research company, whose goal is to make contact with individuals and/or caregivers for those diagnosed with NSCLC. We will be looking to reach out to those who show interest in the form of online surveys and telephone discussion to understand the needs of NSCLC patients. When contacted, qualified and survey completed, we will pay respondents for their time (up to $100).

Identifying personal information collected during the surveys or phone discussions are completely confidential and will not be shown to our clients.

* 1. Please note age when diagnosed.

* 2. Please note year diagnosed (enter 4-digit year, for example, 2010)

* 3. If known please indicate type of NSCLC diagnosed.

* 4. If known please indicate Stage of NSCLC?

* 5. Please provide demographic information. Name, Phone and Zip are optional at this time.

Thank you very much for taking the time to fill out this short questionnaire. We are collecting basic information to match individuals with specific survey requirements in order to invite qualified individuals.

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